Future Research in Health Information Technology: A Review

Abstract

Introduction: Currently, information technology is considered an important tool to improve healthcare services. To adopt the right technologies, policy makers should have adequate information about present and future advances. This study aimed to review and compare studies with a focus on the future of health information technology.

Methods: This review study was completed in 2015. The databases used were Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed. Keyword searches were used to identify papers and materials published between 2000 and 2015. Initially, 407 papers were obtained, and they were reduced to 11 papers at the final stage. The selected papers were described and compared in terms of the country of origin, objective, methodology, and time horizon.

Results: The papers were divided into two groups: those forecasting the future of health information technology (seven papers) and those providing health information technology foresight (four papers). The results showed that papers related to forecasting the future of health information technology were mostly a literature review, and the time horizon was up to 10 years in most of these studies. In the health information technology foresight group, most of the studies used a combination of techniques, such as scenario building and Delphi methods, and had long-term objectives.

Conclusion: To make the most of an investment and to improve planning and successful implementation of health information technology, a strategic plan for the future needs to be set. To achieve this aim, methods such as forecasting the future of health information technology and offering health information technology foresight can be applied. The forecasting method is used when the objectives are not very large, and the foresight approach is recommended when large-scale objectives are set to be achieved. In the field of health information technology, the results of foresight studies can help to establish realistic long-term expectations of the future of health information technology.

Introduction

Information and communication technology (ICT) is a broad term that covers any product that stores, retrieves, manipulates, transmits, or receives information electronically and in a digital form. The application of ICT in healthcare, which is known as health information technology (HIT), includes a variety of technologies that are used to collect, transmit, display, or store patients’ data electronically.1 HIT is also a concept that describes the application of computerized systems to access healthcare information by patients, healthcare providers, insurance companies, and other government agencies. The use of HIT helps to reduce medical errors, costs, and paperwork; increases the efficiency and quality of healthcare; and empowers patients and clinicians.2

HIT includes a wide range of products, technologies, and services, such as remote and mobile health technology, cloud-based services, medical devices, telemonitoring tools, assistant and sensor technologies, electronic health records (EHRs), and other applications of information technology in healthcare. These technologies can help users to collect, share, and use health information for different purposes.3–4

Cresswell and Sheikh argued that the use of HIT tools has been widespread across healthcare settings.5 Because of the proven benefits of such tools, the use of these technologies seems to be inevitable.6–7 However, the balance between benefits and risks of using information technology in healthcare organizations in the coming years is not clear. Therefore, to improve planning and successful implementation of these technologies, the use of technology forecasting methods has been recommended.8 Using these methods, healthcare organizations and policy makers can consider the issues that may occur in the future.9 Because of the rapid development of information technology, the expected benefits and future challenges of HIT will affect decisions made by policy makers.10

According to the literature, two approaches to predicting the future are available: forecasting and foresight.11 Forecasting is the estimation of the short-, medium-, and long-term future in a particular research field. It normally ends with the identification of possible futures; however, forecasting does not necessarily mean a belief in the prediction or the predictability of the future in general.12 Because the traditional methods of forecasting are not reliable approaches for future planning,13–14 systematic approaches, such as a future study, can be used to assess the future to identify future trends and directions correctly.

A future study may be called foresight, strategic foresight, prospective study, prognostic study, or futurology.15 Foresight is widely used to create long-term and medium-term visions for technological development.16 Martin defined foresight as “the process involved in systematically attempting to look into the longer-term future of science, technology, the economy, environment and society with the aim of identifying the emerging generic technologies and the underpinning areas of strategic research likely to yield the greatest economic and social benefits” and stated that “foresight is NOT the same as forecasting—it is a process not a technique.”17

Foresight studies are conducted to gain knowledge so that today’s decisions can be based more solidly on the available expertise. It is more than prognosis or prediction, and it holds the promise of managing uncertainty through intensive interaction between stakeholders.18 Technology foresight identifies the vital technologies of a country or industry that need to be developed to shape the desired future.19 It also is considered one of the most important elements of the technology development process. This process provides outputs to establish technology strategies and infrastructure. In addition, technology foresight supports public and private companies in terms of innovation, technology transfer and management, and competitiveness.20 Today, technology foresight is widely accepted worldwide.21 The most important foresight methods include the Delphi technique (a method of obtaining a consensus of opinions of a group of experts by means of a series of questionnaires and feedback given to the participants), expert panels, literature reviews, scenario building, and identification of key/critical technologies.22

The application of future studies in HIT was proposed by Englebardt and Nelson in Health Care Informatics: An Interdisciplinary Approach in 2002.23 In 2013, another book, titled Health Informatics: An Interprofessional Approach,24 emphasized the use of future studies to analyze the future of health information systems. These books emphasized the necessity of using foresight to provide a basis for designing and constructing future health information systems.

According to the literature review, many studies have investigated the future of HIT using different methods.25–52 However, few studies have used foresight methods.53–56 This study aimed to review the literature on forecasting HIT across the world to help obtain a deeper understanding of HIT forecasting methods.

Methods

In this study, a comprehensive literature review was conducted. The study was completed in 2015.

Search Strategy

A number of databases, such as Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed, were searched to obtain related articles. The keywords foresight, future study, futurology, prospective, prognosis, and future were combined with health information technology (HIT), health informatics, medical informatics, e-health, healthcare IT, health IT, and electronic health record (EHR). Boolean operators (and/or) were used to focus on the most related papers, and the time frame was between 2000 and 2015.

Selection Criteria

All non-English documents and editorial letters were excluded from the study. In addition, if the full text of an article was not available and the researchers were not able to obtain it by contacting the corresponding author, the article was excluded. Because of the limited number of research papers related to the future study of HIT, other documents, such as reports or review studies with a focus on forecasting or foresight of HIT, were included in this study.

Data Classification, Extraction, and Analysis

Initially, 407 papers were identified, and 45 of them were excluded because of duplication. Another 28 papers were removed because of the unavailability of abstracts or full text. The 334 remaining papers were screened with respect to their titles and the relevancy of their abstract to the subject of this study. At this stage, 47 papers were identified as relevant, and their full texts were studied. Having read the full texts, the researchers found that although the term future was used in the topic or the abstract of some papers, many of the papers mostly reviewed the existing literature and suggested the use of new or specific technology in the future or the development of the specific systems, such as EHRs. However, the researchers aimed to review and compare studies in which HIT was seen as a diverse set of technologies and different research methods were used to examine the future of it, preferably within a given time horizon. Therefore, considering the above mentioned criteria, only 11 papers were found appropriate to be reviewed in depth and were included in the study. (See Figure 1.) These papers were examined in terms of the country of origin, study objective, methods, and time horizon.

Results

As noted, the number of studies related to the future study of HIT was limited, and both forecast and foresight studies were included. Therefore, the results of this study are divided into two parts. The first part is related to research with a focus on forecasting the future of HIT (n = 7).57–63 The second part is related to research with a concentration on the foresight of HIT (n = 4).64–67

Forecasting the Future of HIT

According to the literature review, seven studies were related to forecasting the future of HIT. The country of origin, objective, methods, and time horizon of these studies are compared in the following sections.

Country of Origin

Studies related to forecasting the future of HIT were conducted in the United States,68–70 Austria,71 Britain,72 Japan,73 and Bangladesh.74Table 1 shows more information about these studies.

Study Objectives

The papers that forecasted the future of HIT had different objectives. The objective of some papers was investigating the effects of HIT in the future.75–77 Other objectives included providing a road map78–80 and forecasting the acceptance of HIT in the future.81

Haux et al. studied the future of HIT in 10 years (2003 to 2013). They aimed to examine the impact of HIT development on healthcare and forecasted the possible impact in 2013.82 Sittig described some key concepts of clinical information management technologies and how these technologies may affect cancer care in the future.83 Lucas investigated the potential values of various information and communication technology innovations and some of the obstacles that need to be dealt with in developing countries.84 Kuzuno et al. stated their objective as providing a vision of HIT in 2025 to support the ideal vision of healthcare in 2025.85

Bates and Bitton studied the future of HIT with an emphasis on patient-centered medical homes. Their study aimed to provide a road map for different areas of HIT.86 Blavin and Buntin used experts’ opinions to forecast the adoption and meaningful use of EHRs between 2012 and 2019.87 Sheraz et al. concentrated on alternative futures of the use of e-health in decision making in Bangladesh.88

Research Methods

Most of the studies related to forecasting the future of HIT were based on literature review.89–94 However, one study used the six pillars method,95 and one used the Delphi method.96

Haux et al suggested 30 forecasts about the future of HIT based on the results derived from a literature review. They then set a number of objectives to achieve that future.97 Having completed a literature review, Sittig forecasted that in 2015, the next generation of Internet and wireless handheld devices, clinical decision support systems, large and integrated clinical and genetic databases with intelligent data mining techniques, and other related technologies would have a major impact on cancer care.98 Lucas reviewed the literature to determine the potential benefits and challenges of information and communication technology innovations in healthcare settings.99 In another study, Kuzuno et al. forecasted the future of HIT in 2025,100 and Bates and Bitton suggested a road map of HIT based on the existing literature.101

Blavin and Buntin used different methods to complete their research. They conducted a literature review, collected experts’ opinions, and used a modified Delphi technique, the EFTE (estimate, feedback, talk, and estimate) framework, to forecast the application of e-health in the coming years.102 The six pillars approach, a step-by-step approach for thinking about the future to understand the change process, was used by Sheraz et al.103 The six pillars approach focuses on the desired changes. The focus on the future means that more than one possible future can be considered.

Time Horizon

In the studies related to forecasting the future of HIT, a time horizon is considered. Most of the reviewed studies had a 10-year vision.104–106 The time horizon was not specified in two studies107, 108 and few of them had a time horizon longer than 10 years.109, 110

As noted, Haux et al. considered a 10-year vision (2003–2013) in their research.111 Sittig looked at 10 years after the writing of the study, namely 2015.112 Lucas considered the medium-term impact of HIT and did not mention a particular year in the future.113 Kuzuno et al. used a time horizon longer than 15 years and forecasted the future in 2025.114 Bates and Bitton did not consider any specific year in the future and provided a road map for the coming years.115 In the study by Blavin and Buntin, the time horizon was between 2012 and 2019.116 Similar to Kuzuno et al., Sheraz et al. examined a time horizon longer than 15 years, namely 2025.117

HIT Foresight

The literature review showed that a limited number of studies were related to HIT foresight. 118–121 Although the term foresight was not used in some studies, the use of foresight methodologies, such as the Delphi method and scenario building, was considered in the process of selecting these documents. These methods have been used to determine the long-term future of HIT.122, 123 According to the literature review, four studies were related to HIT foresight. The country of origin, objective, methods, and time horizon of these studies are presented in the following sections.

Country of Origin

One study related to HIT foresight was conducted in Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden),124 and one was conducted in Germany.125 Two other studies were conducted in Austria.126, 127 The details of these studies are summarized in Table 2.

Study Objectives

The research objectives of the selected studies were different. Some studies aimed to build scenarios for the future of HIT128 and determine barriers to the use of the technology.129–131 One study examined the feasibility of using the technology.132

The Nordic ICT foresight project was conducted to determine the application of ICT in northern Europe in 2005–2006. This project aimed to identify, select, and build scenarios to determine potential ICT applications with regard to the changes in technology, applications, and markets. The application of ICT in the health sector was part of this project.133 Another project, which was called FAZIT (an acronym for its name in German), aimed to determine the future of information technology and barriers to the use of the technology in the health sector. This foresight study was conducted in 2006–2008 and answered the following questions: How will information technology change healthcare in the coming years? Which of these technologies cause changes? When and how can ICT be used to improve healthcare? What is possible but undesirable in relation to the use of ICT?134

The studies conducted in Austria had different objectives.135, 136 In one study, Haluza and Jungwirth aimed to identify different Austrian stakeholders’ perceptions of the future of clinical information technologies.137 In another study, Haluza and Jungwirth investigated the future of information technology in relation to health promotion. In that study, the researchers collected data about the views and experiences of different stakeholders in Austria.138

Research Methods

Studies that focused on HIT foresight used mixed methods.139–142 For example, the Nordic ICT foresight project included five main steps. In the first step (literature review), the boundaries of the technologies were determined. In the second step (analysis of strengths, weaknesses, opportunities, and threats [SWOT]), the national ICT business processes were identified in the selected countries (Finland, Sweden, Norway, Iceland, and Denmark). The third step included scenario building and workshops. The fourth step involved road mapping workshops in which sociotechnical visions were developed for the knowledge, science, business, market, and governmental sectors. The last step was a workshop in which strategies, action plans, and strategy-related subcategories were identified. Finally, the activities were evaluated to promote the expected results.143

Similarly, in the FAZIT project, a mixed-methods approach was used. Because economic and social trends were investigated in this study, a combination of foresight methods was used. Possible technical and social developments were investigated using a Delphi technique. Initially, the possible information technologies in the next 20 years were identified and were classified in the form of theses. Then, 230 experts in the first phase and 86 experts in the second phase assessed the theses in terms of importance, feasibility, and desirability. Finally, the results derived from the previous phases were used to build a scenario for the future.144

In one study conducted by Haluza and Jungwirth, the future of HIT was investigated in terms of patient-physician relationships. This study included four phases. Initially, scenarios related to the future of HIT were identified. Then, each scenario was evaluated in terms of its future benefits, potential challenges, innovation level, desirability, and year of realization between 2010 and 2030. In the third phase, the Delphi technique was used to collect the experts’ views. Finally, the data were analyzed, and the results were reported to the experts.145 The other study conducted by Haluza and Jungwirth used a similar approach. However, this study differed from the previous one in terms of the subject and the number of scenarios.146

Time Horizon

The time horizon in most studies was more than 20 years.147–149 One study had a 10-year vision, but in practice the time horizon was longer than 10 years.150 Specifically, in the Nordic ICT foresight project, the time horizon was between 2007 and 2017. However, the future roadmap was divided into three categories: short-term (1–5 years), medium-term (5–10 years), and long-term (10 years and more).151 In the FAZIT project, the following time periods were considered: 2006–2010, 2011–2015, 2016–2020, 2021–2025, 2026–2030, and later.152 In both studies conducted by Haluza and Jungwirth, the time horizon was between 2010 and 2030.153, 154

Discussion

The current study showed that research related to forecasting the future of HIT was limited. Although many studies focused on forecasting or estimating the future of HIT,155–161 few studies used systematic approaches to HIT foresight.162–165

Comparison of these two groups of studies revealed that the main difference between them was related to their objectives. In the forecasting studies, the objectives included generating theses for the future,166 providing key concepts,167 determining the advantages and drawbacks of using the technology,168 providing prospects for the future,169 developing a road map for the future of information technology,170 forecasting the use of EHRs,171 and outlining an alternative future.172 Also, in the forecasting studies, the objectives were related to a small number of technologies. In the HIT foresight studies, however, the objectives were complicated. For example, in one study the objectives were the identification, selection, and presentation of scenarios to determine the vision of ICT applications considering changes in technology, applications, and markets.173 In another study, numerous possibilities for the future of HIT were closely examined.174 Investigating the perception of different stakeholders regarding the future of HIT was the objective of other studies.175, 176

Another difference between the foresight studies and other future research was related to the research methodologies. Literature reviews were often used in forecasting the future of HIT,177–181 while more complicated methods, such as modified Delphi182 and six pillars183 techniques, were used in the foresight studies. A combination of a survey, SWOT analysis, a scenario and vision workshop, a road mapping workshop, and an action workshop184 or a combination of a literature review, an expert panel, the Delphi technique, and scenario building were used in HIT foresight studies.185 Some studies used a combination of scenario building and the Delphi technique.186, 187 Moreover, it was found that foresight studies emphasized the opinions of the experts and stakeholders, whereas in the future forecast studies, researchers forecasted the future on the basis of the literature review.

Another difference between the forecast studies and the foresight studies was related to their time horizon. In the future forecast studies, usually a time horizon of 10 years188–190 was considered, and in a few studies, the time horizon was longer than 10 years.191, 192 In some papers, no time horizon was specified, and the future was considered in general.193, 194 In contrast, the foresight studies had a long-term time horizon, usually longer than 10 years, and had a more realistic view of the future.195–198 It is notable that, according to the literature, researchers may consider 5 to 50 years as the future,199, 200 which may cause an overlap between the concepts of foresight and forecasting.201

Finally, a comparison between studies related to forecasting the future of HIT and those providing HIT foresight showed that these two types of study had fundamental differences. The foresight studies focused on networking and making decisions regarding the future. This is one of the reasons that foresight studies have been conducted in many countries and have been substituted for forecasting the future since the 1990s. The results of foresight studies provide information about the future, which is essential for strategic planning and decision making.202 Because efforts to develop and implement health information systems have faced severe economic challenges and growing demands for better services,203, 204 policy makers prefer to use the results of foresight studies in this area to be able to make better decisions and design an appropriate road map with more confidence.

Conclusion

HIT is considered one of the most promising areas of technological development in healthcare. As a result, substantial investments have been made in this area in countries around the world. To make the most of an investment and to improve planning for and successful implementation of these technologies, a strategic plan for the future needs to be established. To achieve this, methods of studying the future of HIT, namely, forecasting the future of HIT and HIT foresight, can be applied. The forecasting method is used when the objectives are not very large, and the foresight approach is recommended when large-scale objectives are set to be achieved. The use of mixed methods in the foresight studies can help to gain a more precise and realistic picture of what has to be done to reach the desired future, whereas forecasting seems to be more theoretical than practical.

HIT foresight can be used to identify, select, and present scenarios for a longer-term future in this field. It seems that the results of such studies can provide a basis for decision making and policy making in the field of HIT, particularly at a national level. Moreover, the involvement of experts and policy makers can help to provide more realistic expectations of the future of HIT in a long-term perspective.

Acknowledgment

This study was funded and supported by Iran University of Medical Sciences, grant no. 115.

Morteza Hemmat, MSc, is a PhD student in the Department of Health Information Management at Iran University of Medical Sciences in Tehran, Iran.

Haleh Ayatollahi, PhD, is an assistant professor of medical informatics in the Department of Health Information Management at Iran University of Medical Sciences in Tehran, Iran.

Mohammad Reza Maleki, PhD, is a professor of health management in the Department of Health Management, Iran University of Medical Sciences in Tehran, Iran.

Fatemeh Saghafi, PhD, is an assistant professor of technology in the School of New Sciences and Technologies at Tehran University in Tehran, Iran.

Martin, B. “Technology Foresight in a Rapidly Globalizing Economy.” Presented at the Regional Conference on Technology Foresight for Central and Eastern Europe and the Newly Independent States, United Nations Industrial Development Organization, Vienna, Austria, April 2001.